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Express Tribune
03-08-2025
- Health
- Express Tribune
Nursing exodus deepens healthcare crisis
Surviving meagre salaries and an overwhelming workload, medical staff from across the country are almost always on the lookout for better work opportunities abroad. While foreign job offers are a golden ticket for the nurses, their exodus leaves behind an irreplaceable void in the local healthcare system. Just like in other provinces, a large number of nurses from Punjab are heading overseas in search of better financial opportunities, professional growth, and improved working conditions. Their top destinations include the Gulf countries, the UK, and Canada. According to the Bureau of Emigration and Overseas Employment, nurses made up around 5.8 per cent of Pakistan's total 'highly educated' workforce that went abroad in 2024. The migrating nurses have revealed that they are offered better salaries and facilities abroad, enabling them to meet their needs more easily. Reportedly, Pakistan requires around 700,000 nurses, while the global demand is even higher. Due to this brain drain, Pakistan's healthcare system is under significant pressure. Between 2019 and 2024, the number of Pakistani nurses registered abroad grew at an average annual rate (CAGR) of 54.2 per cent — a highly concerning figure. This increasing trend has made it even more difficult to provide proper healthcare services in a country already facing a shortage of nurses. Globally, it is estimated that 15 per cent of nurses from developing countries migrate to developed nations each year, with similar patterns observed in Pakistan, where large-scale migration is affecting healthcare services in the country and demotivating new nursing graduates. 'Even though many new nursing colleges have been established in the private sector, the Pakistan Nursing Council is not allocating enough quotas for new nursing students. Since those trained nurses bring in valuable foreign exchange once they start working abroad, the investment in nursing education is worthwhile. However, the lack of support from the Nursing Council is creating hurdles for private colleges,' said the head of a private nursing college. According to the Pakistan Nursing and Midwifery Council (PNMC) the number of registered nurses in the country is far below what is required for a population of over 240 million. Pakistan's nursing-to-doctor ratio is also below global standards. As per PNMC, there were only 116,659 registered nurses in Pakistan in 2020. WHO guidelines stipulate that there should be three nurses per doctor, but in Pakistan, there are only 0.5 nurses to assist each doctor. Official figures have revealed that 727,381 registered professionals left Pakistan in 2024, while over 336,442 have already moved abroad during the first six months of 2025. Sources also revealed that a large number of nurses are going abroad through private arrangements hence no formal record of their migration exists. Punjab's Director General of Nursing, Kausar Parveen, claimed that the number of nurses in the province was low, but the government had taken steps to address the shortfall. 'It is estimated that by 2030, the demand for nurses will reach 100,000. In response, the government has taken measures in collaboration with the University of Health Sciences and both public and private institutions. The shortfall of about 3,000 nurses has already been addressed. Currently, around 44 institutions are offering nursing education across the province,' said Parveen. Unfortunately, however, despite government claims, a significant number of nurses are leaving Pakistan due to economic conditions. While steps are being taken to fill the gap in public healthcare, a shortage remains in the private sector.
Express Tribune
06-04-2025
- Health
- Express Tribune
A legacy of care and leadership
The following is an excerpt from the book Game Changer: The story of Yasmin Amarsi & the Profession of Nursing in Pakistan. The author is a senior journalist with over 26 years of experience and former editor of The Express Tribune. He previously served as Director of the Centre for Excellence in Journalism at IBA, and has also been associated with The News, Dawn and AAJ News. According to the State of the World's Nursing Report 2020, Pakistan faces a shortfall of one million health workers, including nurses. It was to address this shortfall that the government launched the Nursing Now Movement for which then President Arif Alvi, himself from the medical profession, invited over 200 nurses for a meeting in 2018. It was decided to discontinue diploma programs for nurses and focus instead on degree programs to help raise the standard of the profession as well as to be at par with international benchmarking. In the same year, the government launched its National Human Resources for Health Vision for 2030 aimed at developing the skills of the health workforce, particularly of nursing staff. The year 2019 was declared as the Year of Nursing in Pakistan. Big promises were made, including a proposal to set up a nursing university to provide training to 25,000 students every year. However, the promised nursing university is yet to materialize due to a lack of funds and interest from the relevant quarters. Given her prolonged career and her liaison with government agencies, Dr. Amarsi feels one of the reasons the nursing profession is neglected is because, historically, there has been a lack of representation of nurses on committees at the government level. It was only a few years ago that a task force, formed to look into the health sector, included three senior nurses. There is some optimism from the fact that even if the government's efforts have been lukewarm, other stakeholders in the profession are working on improving standards. The Pakistan Nurses Federation, an organization that focuses on the welfare of nurses in Pakistan, helped train several leaders in nursing, which in turn improved membership within the federation. The Federation is considered a prestigious body because the founding leaders of the country, such as Begum Ra'ana Liaquat Ali Khan, took an active interest in it. Similarly, the Pakistan Nursing Council, the regulatory body of the profession in Pakistan, helps standardize nursing education in the country, such as establishing three nursing cadres: Registered Nurse, Registered Midwife and Lady Health Visitor. It also develops the nursing curriculum, conducts examinations, and registers nurses. Most importantly, it licenses nurses to practice professionally. After many years of being led by non-nursing staff, the Pakistan Nursing Council succeeded in having a nurse become its president. Coincidentally, or perhaps not, she was a graduate of AKU-SON. Though a remarkable achievement, the Council still faces criticism for having non-professionals in key decision-making roles. The unfortunate reality is that the medical profession in Pakistan has more doctors than nurses. It has one of the poorest ratios of doctors to nurses and midwives – there is only one nurse for every two doctors. Compare this to the global trend, which requires four nurses for every doctor, and it becomes clear that Pakistan desperately needs more nurses entering the profession. Yet, it is the number of doctors that continues to rise. Between 1980 and 2017, the average increase in the number of male and female doctors per year had nearly doubled and quintupled, from 2,810 male and 976 female doctors to 5,313 and 5,008, respectively. Most families push their children – both sons and daughters -- to become doctors, instead of nurses. There is a widespread belief that doctors earn higher salaries and are more respected as compared to nurses. This is why, until very recently, the nursing profession was reserved for those students who could not meet the entry requirements for medical school or those who could not afford the tuition fees. But Dr. Amarsi finds hope in how the situation is changing. Not only are more women enrolling in nursing, but men are also enrolling in nursing schools. This is significant given that it was not until 1967 that men were allowed into the nursing profession. Initially, men could only work as nurses in the operation theatres but, over the years, they have been allowed into different wards. According to one estimate, the number of male nurses is almost the same as female nurses in Pakistan today. One reason why Dr. Amarsi believes that nursing is becoming an attractive choice for students is because of the high demand for these professionals abroad. Immigration and job prospects are brighter for nurses as compared to many other professions and easier than for doctors. As a result, there has been an increase in nursing schools in Pakistan. While she is happy that the public image of nurses has come a long way, she warns that, although nursing schools are mushrooming, the standard of the educational institution imparting education and teaching on offer is questionable. Her efforts for nursing may continue as she now feels the need is to ensure the profession not only remains acceptable but also credible. It would be apt here to quote how much of a powerhouse Dr. Yasmin Amarsi is seen as by her colleagues. As put by Director for Health at the Aga Khan Development Network (AKDN) Dr. Gijs Walraven: "Dr. Amarsi is the most powerful advocate for the profession of nursing I have ever met. And she does this in her own humbling and charming manner, grounded in her decades of experience as a nursing professional, based on evidence and informed by her learning as a senior academic in different settings and environments.' It is in teaching and interacting with students that Dr. Yasmin Amarsi finds her true sense of fulfillment. Despite no longer holding an official position, she has requested to be included in a few teaching sessions, even if her name does not appear on the official roster. This stems from her deep satisfaction in sharing knowledge, guiding students, and witnessing their growth. Dr. Amarsi, whose dream was to become a doctor but opted for nursing as a career due to the closure of colleges and political strikes in 1968-69, has no regrets whatsoever and never once looked back. On the contrary in an interview she gave after joining AKU-SON, she stated 'I am proud to be a nurse.' To date, after fifty years, she maintains the same views. The motivation and the driving force behind all the achievements and milestones Dr. Amarsi derived from was her sincere desire to help people and elevate the image of the nursing profession in Pakistan. As Dr. Amarsi's story comes to a close, her legacy as an exceptional educator and compassionate mentor will continue to inspire generations of students and future educators, leaving an indelible mark on the world of nursing education.
Express Tribune
21-02-2025
- Health
- Express Tribune
Nursing council probes viral cultural day videos
The Pakistan Nursing and Midwifery Council has launched an official inquiry into 'inappropriate videos' that surfaced on social media following a cultural day ceremony at four private nursing colleges in Khyber-Pakhtunkhwa. The inquiry committee is set to complete its investigation and submit a report to the provincial government within 14 days. According to sources, the Pakistan Nursing Council has issued an official letter to Dir College of Nursing (Lower Dir), Ismail College of Nursing (Swat), Malakand Nursing College (Swat), and Eagle College of Nursing (Swat). The letter states that cultural day was celebrated as part of extracurricular activities at these institutions, but certain 'objectionable' video clips from the event have gone viral on social media. The Pakistan Nursing Council has taken strict notice of these 'inappropriate' videos. Furthermore, the letter asserts that hosting such events in educational institutions is unethical and inappropriate. "Such activities not only tarnish the reputation of the institution but also discourage parents from sending their daughters to educational institutions. Therefore, an official inquiry has been initiated under the Pakistan Nursing Council Act to investigate the matter. The committee will submit its report to the council within 14 days," the letter states. The inquiry committee, operating under the Pakistan Nursing Council Professional Code of Conduct Regulation 2024 and the Pakistan Nursing Council Act 1973, will also review the registration status of these colleges. The colleges have been directed to coordinate with the inquiry committee regarding scheduling and other necessary arrangements. Additionally, the Nursing Council has informed the Health Department about the matter.
